Provider Demographics
NPI:1336137488
Name:FATHER WALTER MEMORIAL CHILD CARE CENTER
Entity Type:Organization
Organization Name:FATHER WALTER MEMORIAL CHILD CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:MISS
Authorized Official - First Name:YATAISHA
Authorized Official - Middle Name:FELEESE
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:334-230-1935
Mailing Address - Street 1:2815 FORBES DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36110-1307
Mailing Address - Country:US
Mailing Address - Phone:334-262-6421
Mailing Address - Fax:334-262-2265
Practice Address - Street 1:2815 FORBES DR
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36110-1307
Practice Address - Country:US
Practice Address - Phone:334-262-6421
Practice Address - Fax:334-262-2265
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL083943140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL4751050SMedicaid